Provider Demographics
NPI:1164831244
Name:COVIELLO, LAURA (EDS)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:COVIELLO
Suffix:
Gender:F
Credentials:EDS
Other - Prefix:
Other - First Name:LAURA
Other - Middle Name:WILDER
Other - Last Name:WEEKS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BA
Mailing Address - Street 1:5571 SHILEY ST
Mailing Address - Street 2:
Mailing Address - City:FORT BLISS
Mailing Address - State:TX
Mailing Address - Zip Code:79906-4034
Mailing Address - Country:US
Mailing Address - Phone:336-972-0369
Mailing Address - Fax:
Practice Address - Street 1:5571 SHILEY ST
Practice Address - Street 2:
Practice Address - City:FORT BLISS
Practice Address - State:TX
Practice Address - Zip Code:79906-4034
Practice Address - Country:US
Practice Address - Phone:336-972-0369
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-04
Last Update Date:2014-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1-14-16599103K00000X
TX70374103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool